Laparoscopic ultrasonic dissectors: technology update by a review of literature

Figures & data

Figure 1 Surgical plume production of different ultrasonic devices.

Note: Reprinted by permission from Springer Nature: Surg Endosc. Kim FJ, Sehrt D, Pompeo A, Molina WR. Laminar and turbulent surgical plume characteristics generated from curved- and straight-blade laparoscopic ultrasonic dissectors. 2014;28(5):1674–167. Copyright 2014.¹¹

Table 1 Performance of current ultrasonic dissectors

Device perfomance	Ethicon’s Harmonic Scalpel (ACE^®)	Covidien’s Sonicision™ (SNC)	Conmed’s SonoSurg^® (SS)	Olympus’s Thunderbeat^® (TB)
Vessel sealing speed (mean time in s)	3.3 ± 1.0	5.2 ± 1.7	Not applicable (N/A; alignment of the jaws does not approximate)	2.43 ± 0.76
Vessel burst pressure (mmHg)	Lowest mean burst pressure	Low mean burst pressure	Moderate mean burst pressure	Highest mean burst pressure
Vessel sealing (maximum diameter)	Up to 7 mm	Up to 5 mm	Up to 5 mm	Up to 7 mm
Visibility	Mist production affecting visibility	Less mist production	Smoke production affecting visibility	Unimpaired visibility
Thermal spread	<1 mm	1 mm ± 0.5 mm	2 mm	Least lateral thermal spread

Note: Reprinted by permission from Springer Nature: Surg Endosc. Newcomb WL, Hope WW, Schmelzer TM, et al. Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices. 2009;23(1):90–96. Copyright 2008;⁴ Fagotti A, Vizzielli G, Fanfani F, et al. Randomized study comparing use of Thunderbeat technology vs standard electrosurgery during laparoscopic radical hysterectomy and pelvic lymphadenectomy for gynecologic cancer. J Minim Invasive Gynecol. 2014;21(3): 447–453²⁰; and Copel M. Performance of Sonicision Cordless Ultrasonic Dissection Device compared to the Harmonic ACE. Covidien (Covidien Test Report no. 2-105-10).²¹

Table 2 Thermal damage at different power settings among different laparoscopic shears

Comparison group	Mean value (μm)	p value
Monopolar diathermy vs. Harmonic Scalpel (ACE^®; output power 3/5)	215.79 vs. 90.42	<0.001
Monopolar diathermy vs. ACE (output power 5/5)	215.79 vs. 127.48	<0.001
Monopolar diathermy vs. LigaSure (LIG)	215.79 vs. 144.18	<0.001
ACE (output power 3/5) vs. ACE (output power 5/5)	90.42 vs. 144.18	0.001
ACE (output power 3/5) vs. LIG	90.42 vs. 127.48	<0.001
ACE (output power 5/5) vs. LIG	127.48 vs. 144.18	0.39
ACE (output power 5/5) vs. SonoSurg^® (SS)	90.49 vs. 117.6	<0.001

Note: Based on Sutton PA, Awad S, Perkins AC, Lobo DN. Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic scalpel and the Ligasure. Br J Surg. 2010;97(3):428–433, with permission from John Wiley and Sons.²³ and Družijanić N, Pogorelić Z, Perko Z, Mrklić I, Tomić S. Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, Harmonic scalpel and LigaSure. Can J Surg. 2012;55(5):317–321.²⁴

Table 3 Comparison of emissivity and maximum cutting temperature in different ultrasonic shears

Type of dissector	Emissivity (mm)	Maximum cutting temperature (°C)
Harmonic Scalpel (ACE^®)	0.49 ± 0.01	191.10
Sonicision™ (SNC)	0.40 ± 0.00	227.1
SonoSurg^® (SS)	0.39 ± 0.01	184.8

Notes: Maximum coagulation temperatures did not differ significantly among devices (p = 0.490). Reprinted by permission from Springer Nature: Surg Endosc. Kim FJ, Sehrt D, da Silva RD, Gustafson D, Nogueira L, Molina WR. Evaluation of emissivity and temperature profile of laparoscopic ultrasonic devices (blades and passive jaws). 2015;29(5):1179–1184. Copyright 2014.²⁶

KimFJSehrtDPompeoAMolinaWRLaminar and turbulent surgical plume characteristics generated from curved- and straight-blade laparoscopic ultrasonic dissectorsSurg Endosc20142851674167724399523

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NewcombWLHopeWWSchmelzerTMComparison of blood vessel sealing among new electrosurgical and ultrasonic devicesSurg Endosc2009231909618483824

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FagottiAVizzielliGFanfaniFRandomized study comparing use of Thunderbeat technology vs standard electrosurgery during laparoscopic radical hysterectomy and pelvic lymphadenectomy for gynecologic cancerJ Minim Invasive Gynecol201421344745324325899

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CopelMPerformance of Sonicision Cordless Ultrasonic Dissection Device compared to the Harmonic ACECovidien (Covidien Test Report no. 2105-10)

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SuttonPAAwadSPerkinsACLoboDNComparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic scalpel and the LigasureBr J Surg201097342843320101674

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DružijanićNPogorelićZPerkoZMrklićITomićSComparison of lateral thermal damage of the human peritoneum using mono-polar diathermy, Harmonic scalpel and LigaSureCan J Surg201255531732122854112

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KimFJSehrtDda SilvaRDGustafsonDNogueiraLMolinaWREvaluation of emissivity and temperature profile of laparoscopic ultrasonic devices (blades and passive jaws)Surg Endosc20152951179118425159635

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